Use of corticosteroid is not associated with improved outcomes in idiopathic pulmonary fibrosis (IPF) patients admitted to the hospital with acute exacerbation (AE), reveals a recent study. In addition, corticosteroids may even contribute to reduced overall survival following exacerbation.

Acne is a common skin problem seen in primary care. Dr Wong
Soon Tee of Assurance Skin Clinic at Mt Elizabeth Novena Hospital, Singapore
shares his insights with Pearl Toh on how to manage acne in the primary care
setting.

Characterizing COVID-19 patients with GI symptoms

Jairia Dela Cruz

14 Apr 2020

There have been a large number of coronavirus disease 2019 (COVID-19) patients outside Wuhan, the epicentre of the pandemic, who presented with gastrointestinal (GI) symptoms, and this group features
greater family clustering and liver injury, severe/critical tendency, and higher rate of body temperature, as reported in a recent study.

“The suspected patients with COVID-19 with GI symptoms, such as nausea, vomiting and diarrhoea, should be seriously considered, since accumulated evidence supports SARS-CoV-2 transmission through faeces and tears, and its ability to bind to ACE2 of the GI tract has been identified,” the investigators said. [N Engl J Med
2020;382:929-936; J Med Virol 2020;doi:10.1002/jmv.25725; J Virol 2020;doi:10.1128/JVI.00127-20;
bioRxiv 2020:927806]

In a population of 651 confirmed COVID-19 patients in the Zhejiang province, 74 (11.4 percent) presented with at least one GI symptom. This patient group was aged 46.14 years on average and had 4-day incubation period.[Gut 2020;doi:10.1136/gutjnl-2020-320926]

Compared with those who did not have the symptoms, COVID-19 patients with GI symptoms were more likely to have severe/critical illness types (22.97 percent vs 8.14 percent), show family clustering of infection (31.08 percent vs 20.45 percent), and have chronic liver disease (10.81 percent vs 2.95 percent).

Low-dose glucocorticoids and antibiotics were administered to 14.86 percent of patients in the GI group and to 41.89 percent of those in the no-GI group. Sputum production and elevated lactate dehydrogenase/glucose levels were associated with a higher likelihood of having severe/critical illness type.

Bioinformatics revealed a novel m6 A methylation loci in the S protein of SARS-CoV-2 and altered binding capacity with ACE2. This finding deserves further exploration and may shed light on the underlining mechanisms for the change in virulence and transmission capacity of COVID-19 during the spread, the investigators noted.

“To our knowledge, this is the first report that describes the situation of patients with COVID-19 GI symptoms and is the largest group of cases outside Wuhan,” they said, adding that the data underscore the significance of paying increased attention to COVID-19 patients with GI and other nonclassic symptoms to protect health providers.

“The national spread and global sporadic appearance of SARS-CoV-2 have become an enormous threat to human beings, and the threat is not restricted to China… It is theoretically plausible that one characteristic of a viral spread is an increased transmission capacity at the cost of decreased virulence, which is also true for SARS-CoV-2,” the investigators explained. [J Med Virol 2020;92:424-432]

“Therefore, caution should be exercised for suspected patients with COVID-19 who had normal body temperatures and visited various outpatient clinics for nonrespiratory symptoms,” they added.

Use of corticosteroid is not associated with improved outcomes in idiopathic pulmonary fibrosis (IPF) patients admitted to the hospital with acute exacerbation (AE), reveals a recent study. In addition, corticosteroids may even contribute to reduced overall survival following exacerbation.

Acne is a common skin problem seen in primary care. Dr Wong
Soon Tee of Assurance Skin Clinic at Mt Elizabeth Novena Hospital, Singapore
shares his insights with Pearl Toh on how to manage acne in the primary care
setting.